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Questions and Answers
What should be avoided during rehabilitation following meniscal repair?
What should be avoided during rehabilitation following meniscal repair?
How soon can a graded running program typically begin post-meniscal repair?
How soon can a graded running program typically begin post-meniscal repair?
Which technique is NOT used to enhance healing in the avascular, central region of the meniscus?
Which technique is NOT used to enhance healing in the avascular, central region of the meniscus?
What is the expected timeline for full activity after meniscal repair?
What is the expected timeline for full activity after meniscal repair?
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What is the maximum flexion expected by week 6 post-meniscal repair?
What is the maximum flexion expected by week 6 post-meniscal repair?
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What characteristic is NOT typically associated with meniscal injuries?
What characteristic is NOT typically associated with meniscal injuries?
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Which of the following scenarios warrants leaving a meniscal injury alone?
Which of the following scenarios warrants leaving a meniscal injury alone?
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What is the earliest rehabilitation activity recommended after arthroscopic debridement?
What is the earliest rehabilitation activity recommended after arthroscopic debridement?
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What is a key criterion for considering meniscal repair?
What is a key criterion for considering meniscal repair?
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Which statement about muscle strengthening after meniscal repair is accurate?
Which statement about muscle strengthening after meniscal repair is accurate?
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What is the recommended timeline for returning to activities like treadmill running after a meniscal injury?
What is the recommended timeline for returning to activities like treadmill running after a meniscal injury?
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Which progression is NOT recommended following arthroscopic debridement?
Which progression is NOT recommended following arthroscopic debridement?
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What symptom is often reproduced with deep squatting in meniscal injuries?
What symptom is often reproduced with deep squatting in meniscal injuries?
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Study Notes
Meniscal Injuries: Mechanisms
- Sudden changes in direction with the foot fixed on the ground (e.g., cutting, pivoting) are common causes.
- Hyperflexion (e.g., landing, certain sports) can also lead to meniscal injuries.
- High-impact compression loads can cause meniscal tears.
- Injuries to the anterior cruciate ligament (ACL) or medial collateral ligament (MCL) sometimes accompany a meniscal tear.
Meniscal Injuries: Signs and Symptoms
- Severe pain immediately after injury, followed by swelling (effusion) within hours.
- A feeling of the knee giving way during the injury.
- Intermittent pain, swelling, and the sensation of the knee giving way can occur later.
- Locking of the knee joint.
- Tenderness along the joint line of the knee.
- Positive McMurray and Apley compression tests.
- Limited range of motion (ROM) and a premature end-feel.
- Symptoms are often aggravated by deep squatting.
- Possible quadriceps inhibition.
Decision-making: Leave Alone
- Partial thickness or small peripheral tears that do not disrupt normal joint mechanics can be managed without surgery.
- A stable meniscus in an otherwise unstable knee may not require immediate intervention.
- Degenerative meniscal tears in a degenerative knee may not always require surgery.
Partial Menisectomy
- A partial meniscectomy is performed when a meniscal tear disrupts knee function and the patient is not a good candidate for repair.
- The goal of debridement is to remove only the injured portion of the meniscus while minimizing healthy tissue removal.
Rehabilitation Following Arthroscopic Debridement
- Muscle Strengthening and Joint Mobility: Begin with isometric exercises, active range of motion (AROM), and posterior capsule mobilization immediately. Progress to soft tissue manipulation around incisions once healed. Gradually advance to progressive resistance exercises (PREs) as tolerated. Consider neuromuscular electrical stimulation (NMES).
- Ambulation: Partial weight bearing (PWB) as tolerated immediately. Progress to full weight bearing (FWB) when walking without a limp (usually within 1-2 weeks).
Rehabilitation Following Arthroscopic Partial Meniscectomy - Return to Activity
- Return to activity, including treadmill running, is possible in 3-4 weeks. Successful return hinges on achieving >70% quadriceps strength and no joint pain or swelling.
- Progress to level surface running, sprinting, and agility training as tolerated.
- Return to full activity usually takes approximately 6 weeks, provided quad strength is >85%.
Meniscal Repair
- Meniscal repair is considered when the tear is located in an area with good blood supply (vascularization), and it's at least 1 cm in length.
Rehabilitation Following Meniscal Repair
- Muscle Strengthening and Joint Mobility: Limited range of motion (PROM) and active range of motion (AROM) for first 2-3 weeks (0-90), progressing to full ROM within 6-8 weeks.
- Begin isometric exercises immediately; avoid resisted hamstring or closed chain exercises for the first 6 weeks.
- Advance to more aggressive strengthening (including closed-chain exercises) at 6 weeks; avoid resisted open-chain hamstring exercises.
- Ambulation: Begin with weight-bearing as tolerated (WBAT). Maintain the knee brace locked in extension for the first 1-2 weeks. Gradually wean off crutches and transition to full weight bearing (FWB) ambulation.
Rehabilitation Following Meniscal Repair - Return to Activity
- Begin a graded running program on a treadmill after 3-6 months, depending on quadriceps strength, absence of joint pain and/or effusion.
- Return to full activity is not always possible within 6 months and could take much longer depending on how effectively the patient progresses with running and agility exercises. Post-operative failure is frequently caused by too much early activity.
Meniscal Repair of Avascular, Central Region
- Repair of meniscal tears in the avascular central region is becoming a more common approach.
- Modifications of surgical techniques to improve healing in this area include using fibrin clots, meticulously rasping the synovial fringe, and creating vascular access channels.
Outcomes of Meniscal Repair of Avascular, Central Region
- Noyes et al. (2002) reported promising outcomes. In a study involving 71 knees of individuals with age 19 years or less, with 18 to 51 months of follow-up, nearly 75% had no symptoms and no signs of failure upon followup observation.
- An earlier study by Noyes et al. (2000) reported similar outcomes. In a study involving 30 patients with an average of 34 months post-operative follow-up, 26 patients were symptom-free and did not require further surgery.
Rehabilitation Protocol - Meniscal Repair (Noyes et al., 2002)
- Immediate: Start with knee motion from 0-90 degrees
- Week 3-4: Increase knee flexion to 120 degrees
- Week 5-6: Extend flexion to 135 degrees
- First 4 weeks: Crutch ambulation, starting with touch weight bearing
- Week 6: Gradual increase to full weight bearing
- 6 months: Avoid deep squatting, running, jumping, cutting, or twisting
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Description
Test your knowledge on the rehabilitation process following meniscal repair. This quiz covers essential aspects such as timelines, running programs, and techniques for enhancing healing. Challenge yourself to understand what to expect and what to avoid during recovery.
